Approached from the drivers of organisational scope, the answer to each question is: any organisation, once responding to the horizontal drivers of performance becomes more important than remaining subject solely to the constraints imposed by its vertical controls, since under these conditions the organisation is in a complex and therefore ‘turbulent‘ environment in which clients must be responded to one-by-one. Health and social care are good examples of such an environment, but all industries are moving towards this condition under the influence of information technologies and the increasing prevalence of multi-sided demands, the necessary corollary being the use of platform strategies.[1] Another kind of answer is: “if competition pushes you into the ‘red zone’ in the diagram below”.

It is easier to understand this ‘red zone’ if we start by considering what makes triple-loop learning not necessary. The diagram approaches this in terms of the way role and task are aligned to each other, requisite authority being whatever role definition is congruent with the task demands on the organisation. Triple-loop learning is not necessary as long as the ‘red zone’ can be avoided, the ‘double diamond’ providing a diagnostic tool for identifying this condition:

Task: Either there are no dynamic cross-boundary relations to demand situations that are driving performance (e.g. providing medical equipment), or, if there are, then they can be responded to solely in terms of a choices defined by the organisation ex ante (e.g. providing a menu of in-home services)

Role: Either there is no accountability for performance in the demand situation (e.g. performance of the equipment once sold is down to the purchaser), or, if there is, then the accountability is to the person who signed the contract and not to performance within the situation itself (e.g. “if you are not satisfied with my performance, then take it up with my manager and don’t complain to me”).

Requisite authority involves there being congruence between the role and task sides of this diagram. Lack of congruence means either too much organisational complexity or inadequate organisational support, depending on which way it goes.

We can add labels to the different parts of this diagram to make it clearer when triple-loop learning does become necessary:

Task: There is a dynamic relationship to the client’s situation that demands the dynamic alignment of differentiated behaviors and that involves dynamic linkages across the boundaries of the organisation (e.g. a care pathway has to be configured and continuously adapted to the needs of the individual client).

Role: Responsibility for responding appropriately involves bringing together a number of services from different organisations and holding them accountable in ways that are sustainable and that relate explicitly to performance within the client’s context-of-use (e.g. a care manager responsible for through-life management of the client’s condition and accountable directly to the client).

Examining a particular case situation, a hospital group wanted to provide seamless care to patients admitted through their Emergency Department (ED). The task on the right was therefore to provide a condition-centric episode of care, the episodes being designed one-by-one. The problem was that the ED was in a matrix relationship to the specialist wards with which it had to negotiate admission after having admitted the patient to ED. This negotiation was constrained by considerations other than the patient’s condition, such as the receiving ward’s budgets.The proposed solution was to create an ED diagnostic team that had the power to determine where a patient went from ED. The danger with this was that did not provide requisite authority, simply relocated where power was held without addressing the underlying challenges of designing and aligning care pathways that were sustainable across the hospital group’s ecosystem. The solution was to set up a forensic process that could track and evaluate the performance of the ecosystem in order to learn what forms of agility were needed beyond the establishment of the diagnostic team.

The outcome from this process was a new organisational capability to backtrack ED admissions and to examine them as symptoms of failure in the primary social and healthcare systems. This led to new ways of managing patients’ chronic conditions and failures in care funding.

Notes
[1] The multi-sided platform strategies of Apple, Google and Amazon are also good examples of this, as are the failures of Nokia and Blackberry through their continuing pursuit of one-sided strategies in environments demanding multi-sideness.